Keeping Your Distance And Avoiding Close Contact With People
Stay away from crowded places and avoid using public transport. If you live or work with other people, you will need to keep a distance from them. Avoid standing or sitting close to them. This stops them from getting radiation from you.;
Your doctor will tell you not to have close, lengthy contact with others for a couple of weeks. This includes babies, young children, pets and pregnant women. Avoid hugging and kissing other people.
What Is Radioactive Iodine
Iodine, in the form of iodide, is made into two radioactive forms of iodine that are commonly used in patients with thyroid diseases: I-123 and I-131 . The radiation emitted by each of these forms of iodine can be detected from outside the patient to gain information about thyroid function and take pictures of the size and location of thyroid tissues. RAI is safe to use in individuals who have had allergic reactions to seafood or X-ray contrast agents, since the reaction is to the compound containing iodine, not the iodine itself. RAI is given by mouth in pill or liquid form.
External Beam Radiation Therapy
External beam radiation therapy or EBRT uses a machine with high-energy rays from outside the body to kill cancer cells or slow their growth.;
This type of radiation therapy mostly treats medullary thyroid cancers and anaplastic thyroid cancers.
Additionally, external radiation therapy is often used for cancers that dont take up iodine and when cancer has spread beyond the thyroid . It may also lower the chance of cancer coming back in the neck after surgery.
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Rai Frequently Asked Questions
- Can I isolate myself in a hotel room? ;No, this is not recommended as there is potential that the housekeeping staff will come in contact with the RAI you discharge from your body. This may include pregnant women.
- How do I protect my children? If you have young children, it is best that they stay with a relative for the first few days, or that you stay in hospital isolation. Other alternatives are: a basement apartment, a cottage, or friends empty house/rooms.
- What after-effects can I expect?;Most people have few after-effects or they are very temporary. Almost all patients treated with RAI have an altered sense of taste for the first few days or weeks . Infrequently, the effect lasts longer.
- In some cases, patients experience RAI damage to their salivary glands and/or tear ducts . For most people, the effects are temporary. Those who have lasting effects may experience mild pain in their cheeks, mouth dryness and/or blocked tear ducts. Some may require treatment from specialists in corresponding fields of medicine.
- Occasionally, months later, patients feel some after-effects of RAI as soreness or swelling in glands . This usually lasts less than two weeks.
Why Do I Need To Stay In Hospital
Once you have had your treatment, both you and your bodily fluids will contain radioactive material.; This material will be emitting radiation similar to X-rays and as a result people around you could get a radiation dose that they do not need.
Almost all of the iodine will pass out of your body over the first few days after your treatment.; Most of the I-131 will pass out in your urine but some will be excreted in your sweat and saliva and it is very important that other people do not come into contact with this.
The treatment room has been set up in a way that limits the amount of radiation anyone can receive from you.; It is also easily cleaned so that our staff can remove the iodine from the surfaces and materials in the room before it is used for another patient.
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Follicular Thyroid Cancer Treatment With Rai : How And How Much Treatment
Follicular thyroid cancer guidelines for post operative treatment with radioactive iodine were last updated in the American Thyroid Association 2015 edition. Some endocrinologists and nuclear medicine specialists order a preliminary nuclear study called a thyroid cancer uptake study. After your doctor has prepared your body for RAI by either stopping your use of thyroid hormone pills or giving injections of recombinant TSH , they may choose to give you a small dose of RAI and perform a special nuclear scan called a Thyroid Cancer Uptake Study. This is a very low quantity of radioactive iodine and may be I131 or I123. In most cases, it is done the day before the higher dose RAI treatment.
There are several potential benefits in obtaining a Thyroid Cancer Uptake Study:
- 1)The follicular thyroid cancer’s ability to produce the blood marker thyroglobulin is determined while the patient is in a hypothyroid state . This is called a stimulated thyroglobulin level. This gives the thyroid cancer team a good “feel” for whether you any disease whatsoever and the likelihood for cure. 2)Where the follicular thyroid cancer exists in the body and how much of the swallowed dose or radioactive iodine is taken up by the cancer is able to be determined by the nuclear scan. 3)The thyroid cancer uptake study can be utilized to determine the optimal dose of the radioactive iodine treatment the following day.
Some argue against obtaining Thyroid Cancer Uptake Studies because:
After Thyroid Cancer Treatments
Normally, thyroid cancer survivors are affected emotionally and face several health problems. But, their greatest concern is facing cancer again or that their cancer develops a new-unrelated cancer .;
Regrettably, being treated for cancer does not mean you cant get another. In fact, thyroid cancer patients may be at risk for certain types of cancer including:
- Breast cancer
- Adrenal cancer
- Prostate cancer
The great news isAmerican Cancer Society has recommendations to lower the risk of getting a second cancer and to maintain good health.
The American Cancer Society advice thyroid cancer survivors to:
- Avoid tobacco smoke at all cost
- Get to and stay at a healthy weight
- Practice a healthy eating pattern
- Do not drink alcohol, but if you dohave no more than 1 glass per day and 2 per day
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Physical Emotional And Social Effects Of Cancer
Thyroid cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Treatment And Safety Precautions
Taking RAI typically means ingesting pills or a small amount of liquid that makes you radioactive temporarily. You may be given medicine beforehand to counter any nausea the RAI may cause.
After swallowing your dose, you need to keep away from people for a period of time, and ensure you dont accidentally contaminate others, especially children and pregnant women.
Protect members of your household by staying at least 3 feet away. Dont take public transport. If someone drives you home, sit as far as possible away from themin the rear seat on the opposite side of the driver, for example. If allowed to drive home, do so alone.
Your body will excrete RAI through urine, stool, saliva and sweat. You will need to avoid touching, kissing and having sex or sleeping with anyone for a time. Sleep in a separate room and use a separate bathroom, if possible, following directions on how to clean up the bathroom after each use and safely dispose of tissues or other refuse soiled with blood or secretions. You cannot share dishes or eating utensils, clothing, washcloths or towels until the period of high radioactivity has passed. How many days you must stay away from others depends upon the dose size.
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Return To Clinical Scenario
Are the present guidelines on the use of RAI adequate or should the threshold for RAI use be decreased? Should RAI have been utilized sooner in our case, after the patient’s completion thyroidectomy?
The effectiveness of RAI ablation decreasing recurrence and possibly mortality in low-risk patients with well-differentiated thyroid carcinoma after thyroidectomy has not been clearly determined . The ATA guidelines suggest that routine follow-up diagnostic WBS one year after RAI ablation is not even required in low-risk patients . Given the risks associated with RAI, efforts have been made to reduce unnecessary administration in patients not expected to benefit from treatment. In these low-risk patients, a combination of neck ultrasound and rhTSH-stimulated serum Tg may be effective and adequate for detecting persistent or recurrent disease.
In a randomized trial comparing two thyrotropin-stimulation methods and two radioiodine-131 doses, complete ablation was achieved in 631 of 684 patients. The patients were of the following stages: pT1 and N1 or Nx, pT1 and any N stage, or pT2N0 . The authors concluded that the use of recombinant human thyrotropin and a low dose of I-131 for postoperative RAI ablation represented an effective and attractive option for the management of low-risk thyroid cancer that reduced the amount of whole-body irradiation.
Radioactive Iodine And The Thyroid
Radioactive iodine, or RAI, refers to two forms of iodine.
- I-123 is used to make images of the thyroid and monitor its activity. Its harmless and doesnt kill thyroid cells.
- I-131 does kill thyroid cells. In addition to cancer treatment, doctors deploy I-131 to treat an overactive thyroid and overgrown thyroid .
In this article, radioactive iodine will refer to treatment with I-131.
The thyroid gland, which straddles the windpipe in the neck, needs iodine to make several hormones. It obtains iodine from food, as your body cant make it. Thyroid hormones control metabolism and affect how the digestive system, heart and muscles work, as well as maintain healthy bones and brain development. A low supply of iodine may cause goiters and hypothyroidism, characterized by dry skin, slow heart rate, weight gain and more frequent and intense menstrual periods. A shortage may also cause cognitive disabilities in infants and babies in utero.
Unlike other parts of the body, the thyroid absorbs and retains iodine, making RAI a targeted way of treating thyroid cancer directly with radiation without harming most other tissues. It gets to work quickly, killing cancer cells in the thyroid.
- Its regarded as standard practice for treatment of papillary or follicular thyroid cancer that has grown beyond the thyroid .
- For cancers contained within the gland, surgery without radioactive iodine treatment may be preferred .
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Does Rai For Thyroid Imaging Provide The Best Results
I-123 is the usual isotope used to take pictures and determine the activity of the intact thyroid gland , since it is harmless to thyroid cells. No special radiation precautions are necessary after a thyroid scan or RAIU using I-123. I-131 can also be used to take pictures of the thyroid gland, although it is rarely used due to the harmful effects it has on thyroid cells.
How Is The Procedure Performed
Treatment for hyperthyroidism is almost always done on an outpatient basis because the dose required is relatively small.
The radioiodine I-131 is swallowed in a single dose, in capsule or liquid form, and is quickly absorbed into the bloodstream in the gastrointestinal tract and concentrated from the blood by the thyroid gland, where it begins destroying the gland’s cells. Although the radioactivity from this treatment remains in the thyroid for some time, it is greatly diminished within a few days. The effect of this treatment on the thyroid gland usually takes between one and three months to develop, with maximum benefit occurring three to six months after treatment. Usually, a single dose is successful in treating hyperthyroidism. However, rarely, a second treatment is needed, and very rarely a third treatment may be needed.
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Thyroid Medicine After Radioactive Iodine Treatment
You may have stopped taking your thyroid hormone tablets in preparation for your treatment.;Your nurse will tell you when you should;start to take them again. Usually, this is 2 to 3 days after your treatment.
You will need to take thyroxine tablets to replace the hormones that your thyroid gland normally makes. Your doctors will want to keep your thyroid hormones at a slightly higher level than you would normally need. This is to stop your body producing another hormone called thyroid stimulating hormone . TSH can help some types of thyroid cancer cells to grow.
The doctors will work out the correct dose for you and when to start taking it.
Before Your Radioactive Iodine Treatment
For your treatment to work, one of the hormone levels in your body needs to be high. This hormone is called thyroid stimulating hormone or TSH. A high level of TSH helps any thyroid cancer cells in the body to take up radioactive iodine.
To increase the levels of TSH, your doctor will ask you to do one of the following:
- have an injection of a man-made TSH called recombinant human TSH once a day for 2 days
- stop taking your thyroid hormone tablets a few weeks before treatment
Your healthcare team will explain what you need to do and what is going to happen. They will also let you know when to re-start your hormone tablets if they have asked you;to stop taking them.
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Radioactive Iodine Therapy For Thyroid Nodules & Cancers
NYU Langone doctors may prescribe radioactive iodine therapy to manage some toxic, or overactive, nodules and some types of thyroid cancers.
They may prescribe it for people with a toxic nodule or a toxic multinodular goiter, which produce high levels of thyroxine and can lead to a condition called hyperthyroidism.
The therapy is especially beneficial for people with toxic nodules that do not respond to other medications or who need medication throughout their lifetime. Radioactive iodine therapy may also help shrink a large toxic multinodular goiter.
In this treatment, doctors give you a pill or liquid containing radioactive iodine. Iodine is a mineral found in table salt, seafood, and dairy products that the thyroid absorbs from the bloodstream and converts into thyroid hormone. Radioactive iodine travels to the thyroid, where it is absorbed and gradually destroys overactive thyroid tissue, along with other thyroid tissue.
Radioactive iodine may also be helpful for people with certain types of thyroid cancer. Papillary and follicular thyroid cancers develop from follicular cells, which absorb iodine. When you are given radioactive iodine, it is taken up by cancer cells and destroys themincluding those that have spread to the lymph nodes or other parts of the body.
If youve had surgery for papillary or follicular thyroid cancer, your doctor may prescribe radioactive iodine afterward. It may help prevent the cancer from returning.
How Can I Prepare For Rai
One way to maximize the effects of RAI is by raising your TSH level.; There are 2 ways to do this:
For either, it is also recommended that you go on a Low Iodine Diet.;
Because you are receiving a radioactive substance, there are some precautions you should be aware of. The resources below can help you prepare:
- A list of RAI Isolation Room Essentials;to bring if you are in a hospital isolation room, following your RAI treatment
- RAI precautions, by Ian Adam
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Are There Long Term Risks Of I
In general, RAI is a safe and effective treatment for the thyroid disorders mentioned above. Hypothyroidism is a common side effect of RAI for hyperthyroidism and always seen after RAI for thyroid cancer. This is usually easily treated with thyroid hormone replacement . Some studies suggest a slight increase in thyroid cancers may be seen after RAI treatment for hyperthyroidism. Loss of taste and dry mouth due to salivary gland damage may be seen. The use of lemon drops, vitamin C or sour stimulation to potentially decrease the exposure of the salivary glands to RAI is controversial and should be discussed with your physician. Importantly, once you have been treated with RAI, regular medical follow-up is lifelong.
Where Will I Have My Treatment
You will be given your treatment in an isolation room which has been specially adapted for patients who have been administered radioactive medicines. This room is on Ward 31 in the Queens Centre for Oncology and Haematology at Castle Hill Hospital. The room is set-up to keep you as comfortable as possible during your stay.
As well as the standard hospital bed and equipment, the room has an en-suite shower and toilet, a small kitchen area with a kettle, sink, and refrigerator. The window in the room looks out over the valley to fields in the background.
There is a TV and radio in the room which are both free of charge and will receive the majority of free TV stations and non-digital radio stations.; There is also a portable DVD player which you may use to watch your own DVDs.
The room has a telephone which will receive in-coming calls.; The ward staff will be able to give you the number of this telephone to pass to your family and friends.; It will also allow you to contact the ward staff if you need anything whilst you are in the room.
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